To Have or Not to Have - The Pacifier

My Story

I will admit I am biased against the prolonged use of pacifiers for babies. This bias is not unfounded however but stems from a personal first hand experience I had as a child with my baby sister, who was the first one in my family born in the US and who had all the benefits of a modern society at birth - which included a pacifier.

The pacifier became a vital part of my sister for she was addictively attached to it. If it was misplaced, the whole family would be up in an uproar searching high and low to find it otherwise face the dire consequence of a loud irritated crying baby that somehow wouldn't tire.

When my sister turned three, the pediatrician advised my mom to take away the pacifier. It became one of the most difficult tasks we, as a family, had to endure. After many difficult sleepless nights for my parents, she was finally weaned off the pacifier right before starting preschool. By then she had developed a large open bite, crooked teeth as well as a speech delay. As she grew, she needed braces and the extraction of multiple primary teeth as well as permanent teeth. When my brother was born a few years later, my mom opted out of giving him the pacifier;remembering the dilemma she had weaning my sister off. Interestingly, in his case, there was no speech delay or crooked teeth. As a matter of fact, the only one in my family that needed braces was the sister who had been attached to the pacifier.

I didn't make the connection of how detrimental an open bite is in a growing child until much later in my dental school education. Parents are warned of dental issues with prolong use of a pacifier but when you are encouraged to give it to your infant by pediatricians and nurses, you assume it is safe to use.

In my practice today, I encounter quite a few infants and toddlers that have a pacifier seemingly permanently attached to their mouths and, if by chance, it falls out then mom is there to pop it right back in. It annoys me to no end when I see such ignorant behavior, in the name of love. I try gently yet firmly to advise them that weaning the pacifiers off is necessary. Most moms are afraid of irritating the baby and if the pacifier soothes them then they refuse to take it way. Imagine my dilemma when I see this type of behavior in children who are not my patients.

History In a nut shell

In the hope of not letting my personal bias color my ability to subjectively advise parents on the use of pacifiers I combed thru history and discovered pacifiers are not a device of the modern society at all but are rooted back to many thousands of years ago and can be found in nearly every culture-that had babies that were fussy.

The first time the pacifier was cited in medical history was in 1473 by German physician Bartholomaus Metlinger in his book Regimen der Jungen Kinder ' A Guide on Young Children'. But they were around way before that. There is evidence that precursors to the pacifier have been used as far back as the Neolithic period to calm young children.

A fun fact- there is a painting of the Madonna and child painted by Durer in 1506 which shows a cloth tied 'pacifier' in the baby's hand.

The so called 'sugar rag' was a piece of old linen wrapped around a sugary substance and was very popular in many parts of Northern Europe .

They were a precursor to the development of hard teething rings which were made out of ivory, coral or even bone usually mounted in silver as a handle of a rattle. These in turn were a precursor to the evolution of the pacifier we know of today.

The modern day version was developed by a Manhattan druggist by the name of Christian Weinecke in 1901. In 1940 one New York company , Binky Baby Products of New York, sold so many pacifiers that it became a generic term. In fact it's a Playtex owned trade mark now. The material used to manufacture pacifiers has changed much over the years from India rubber to latex to silicone.

What Do The Pediatricians Say?

SIDS

The American academy of pediatrics recommends the use of pacifiers when placing the infant to sleep during the first year of life. For reasons not completely known, incidences of sudden infant death syndrome (SIDS) has decreased with the use of pacifiers. There are certain guidelines that are recommended :

-It's not recommended to force a pacifier if the infant doesn't want it and there's no need to reinsert if it falls out of a sleeping baby's mouth.

-The pacifier should never be coated in a sweet solution.

-It shouldn't be introduced to a breastfeeding newborn until it is one month of age, giving an ample opportunity for breastfeeding to be fully established.

-The pacifier should be offer to a baby who is not hunger and not used to delay or be in lieu of a meal.

-Pacifiers should be made of single piece durable material that has ventilation holes and the shield is wider than the baby's mouth.

-It should be sanitized and replaced often if it looks worn.

-Lastly, it should never be tied to the crib or around the baby's hand or neck to avoid the risk of strangulation

Nonnutritive sucking

There are many reasons why pacifiers are important and are needed. Preterm babies, for example, are given pacifiers to help develop the sucking behavior and improve digestion. By 28 weeks of gestation, the ability to suck and swallow is present but its not until 32-34 weeks of gestation that it's fully coordinated. Preterm babies born before 32 week gestation are usually unable to effectively feed from breast or bottle. They are fed by a small tube in their nose that goes to their stomach ( gavage feeding). A pacifier is given during gavage feedings to in part help develop the sucking behavior as well as improve digestion of the feeding. Pacifiers also have a soothing effect on the infant but there is always a potential of interference of breastfeeding.

Nonnutritive sucking habits are a natural reflex for babies seen usually around the 29th week of gestation. Its estimated that 100% of babies partake in some form of nonnutritive sucking. The most common of which are thumb sucking and pacifier usage. The other forms of nonnutritive sucking include but aren't limited to sucking on fingers, toes, toys and blankets. These are a normal healthy way babies self soothe. There are several benefits for infants who engage in these habits. Firstly, this demonstrates the infant's early ability to self manage his/her emotions. Using a pacifier or thumb can allow an infant to relax and center his/her attention. Typically this behavior occurs when a baby is tired, irritable, distressed, apprehensive and bored and by performing these habits the baby has a sense of comfort and safety .

Pediatric Dentists Have A Say

The American academy of pediatric dentistry recommend nonnutritive sucking habits should stop by age three. This will allow the teeth to naturally self correct and realign with little to no manipulation. Understandably, stopping pacifier usage is a bit easier than stopping a thumb sucking habit.

However, these habits will start causing problems if they aren't addressed as the child becomes older.

How much position the teeth change in the oral cavity is due directly to the intensity, duration, frequency of the habit as well as how the thumb or finger is placed in the baby's mouth. The most commonly identified form of malocclusion caused by nonnutritive sucking is an open bite-which occurs when the upper and lower incisors do not overlap when the molars bite together. The upper incisors many times are flared outward and the lower incisors inclined inward. The upper jaw is the one most affected as it becomes constricted and the palate narrowed.

Tricks and tips

My favorite way of saying good bye to the pacifier is by telling the 'story of the PACIFIER FAIRY'. Set a date when she will be visiting. Make a big deal about it. Involve all family members who interact with the toddler i.e. grandparents, uncles, aunts, siblings and childcare helpers. Have a spectacular gift ready from the 'pacifier fairy'. The pacifier should be gone - cold turkey. No one can be blamed since the Pacifier Fairy took the pacifier. I usually recommend having the child pick out his/her gift in the toy store beforehand - within reason of course. Friday nights usually work better. This way there is a full weekend dealing with the tears resulting from the consequential pacifier loss. As long as everyone stands firm, the pacifier will become part of the past.

It's a bit different with the thumb/finger sucking habit.

-Have a one to one conversation with the child. If a child fully understands the detrimental effect the habit is having on his/her oral development then that may be enough to galvanize them to stop. The child has to be ready and want to stop for this technique to work.

-implement a rewards system . It should be something that motivates the child to stop and reasonable enough to achieve. Small steps will go a lot further then ultimatums.

- interruption by physical deterrents is inevitable if the other two approaches don't work. Start with a fancy glitzy band aide wrapped on the thumb/ finger as a reminder to stop. Wrapping the arm at night may also help. Last resort is a visit to the pediatric dentist for a habit correcting device which is non removable and guaranteed to succeed.

In conclusion

Pacifiers have a very real and needed place in an infant's life. It is up to the caregiver to ensure that the need doesn't become an obsession as the infant grows. By limiting usage and weaning off early, a lot of tears and tantrums can be minimized if not eliminated altogether.

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